Organization
THE PARK MEDICAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN BRUNNQUELL (DELEGATED OFFICIAL)
(201) 784-0123
Entity
Organization
Contact information
Practice address
163 PARIS AVE, NORTHVALE, NJ 07647-2028
(201) 768-9090
(201) 768-9009
Mailing address
24 ELM ST, HARRINGTON PARK, NJ 07640-1902
(201) 784-0123
(201) 784-0065
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA05743400
NJ
Other
Enumeration date
11/13/2006
Last updated
08/22/2020
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